Hysterectomy for benign disease: clinical practice guidelines from the French College of Obstetrics and Gynecology

• Published in: European Journal of Obstetrics & Gynecology and Reproductive Biology 2016-07, Vol.202, p.83-91
• Main Authors: Deffieux, Xavier, Rochambeau, Bertrand de, Chene, Gautier, Gauthier, Tristan, Huet, Samantha, Lamblin, Géry, Agostini, Aubert, Marcelli, Maxime, Golfier, François
• Format: Article
• Language: English
• Subjects: Bowel injury; Complication; Economics and Finance; Female; Hemorrhage; Human health and pathology; Humanities and Social Sciences; Humans; Hysterectomy; Hysterectomy - methods; Life Sciences; Morcellation; Obstetrics and Gynecology; Psychiatrics and mental health; Psychology; Santé publique et épidémiologie; Urinary tract injury; Uterine Diseases - surgery
• ISSN: 0301-2115; 1872-7654; 2590-1613
• DOI: 10.1016/j.ejogrb.2016.04.006

Abstract Objective The objective of the study was to draw up French College of Obstetrics and Gynecology (CNGOF) clinical practice guidelines based on the best available evidence concerning hysterectomy for benign disease. Methods Each recommendation for practice was allocated a grade, which depends on the level of evidence (clinical practice guidelines). Results Hysterectomy should be performed by a high-volume surgeon (>10 hysterectomy procedures per year) (grade C). Stimulant laxatives taken as a rectal enema are not recommended prior to hysterectomy (grade C). It is recommended to carry out vaginal disinfection using povidone-iodine solution prior to hysterectomy (grade B). Antibiotic prophylaxis is recommended during hysterectomy, regardless of the surgical approach (grade B). The vaginal or laparoscopic approach is recommended for hysterectomy for benign disease (grade B), even if the uterus is large and/or the patient is obese (grade C). The choice between these two surgical approaches depends on other parameters, such as the surgeon's experience, the mode of anesthesia, and organizational constraints (duration of surgery and medical economic factors). Vaginal hysterectomy is not contraindicated in nulliparous women (grade C) or in women with previous cesarean section (grade C). No specific hemostatic technique is recommended with a view to avoiding urinary tract injury (grade C). In the absence of ovarian disease and a personal or family history of breast/ovarian carcinoma, the ovaries should be preserved in pre-menopausal women (grade B). Subtotal hysterectomy is not recommended with a view to reducing the risk of peri- or postoperative complications (grade B). Conclusion The application of these recommendations should minimize risks associated with hysterectomy.